2025 CPT code 32320
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Surgery Feed
Decortication and parietal pleurectomy; removal of fibrous tissue from the lung surface and lining of the chest wall.
Modifiers may be applicable depending on the circumstances of the procedure. For example, modifier 59 (distinct procedural service) may be necessary if another procedure is performed on the same day but is considered distinct from the decortication and pleurectomy.
Medical necessity for decortication and parietal pleurectomy is established when a patient has symptomatic pleural disease that causes significant respiratory compromise due to restricted lung expansion. The condition must be unresponsive to medical management and pose a significant threat to the patient's respiratory health. Documentation supporting the medical necessity will include detailed imaging studies, clinical assessments, and prior attempts at conservative treatments.
The cardiothoracic surgeon is responsible for performing the decortication and pleurectomy.This includes making the incision, accessing the pleural space, removing the fibrous tissue and parietal pleura, ensuring hemostasis, and closing the incision.Pre-operative and post-operative care is a shared responsibility among the surgical team.
In simple words: This surgery removes a thick, scar-like layer around the lung and the lining of the chest cavity. This layer can restrict breathing. The surgeon makes a cut to access the lung and removes the extra tissue, allowing the lung to expand normally.
Decortication and parietal pleurectomy involves the surgical removal of a fibrous membrane that has abnormally formed on the surface of the lung, chest wall, or diaphragm, along with the excision of the pleura lining the thoracic cavity.This procedure is indicated for conditions causing pleural thickening and restricted lung expansion, such as empyema, fibrothorax, or post-traumatic hemothorax. The surgeon makes an incision (thoracotomy or sternotomy), accesses the pleural space, and carefully removes the fibrous tissue and parietal pleura, ensuring complete lung re-expansion. The incision is then closed.
Example 1: A patient presents with chronic empyema (long-standing infection of the pleural space) resulting in significant lung restriction.Decortication and parietal pleurectomy are performed to remove the infected and thickened pleural tissue, restoring lung function., A patient experiences post-traumatic hemothorax (blood accumulation in the pleural space) leading to fibrous tissue formation and restricted lung expansion.Surgical decortication and pleurectomy are performed to remove the fibrous capsule and restore normal lung mechanics., A patient suffers from a malignant pleural mesothelioma. After evaluating imaging and pathology, the physician determines the patient is a candidate for pleurectomy/decortication with the goal of cytoreductive surgery to enhance response to chemotherapy. The surgeon performs a combined decortication and parietal pleurectomy to resect visible tumor.
* Pre-operative chest x-rays, CT scans, and/or other imaging studies to assess the extent of pleural thickening and lung involvement.* Intraoperative findings, including details of the procedure, amount of tissue removed, and any complications.* Post-operative chest x-rays to confirm lung re-expansion.* Pathology reports of the removed tissue.* Complete medical history, including the diagnosis and clinical indication for surgery.
** The procedure may be performed via open thoracotomy or minimally invasive video-assisted thoracoscopic surgery (VATS), which will affect the coding and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Cardiothoracic Surgery, Thoracic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center